Labor Patterns

Long and steady: This is the labor pattern in which the contractions come at fairly regular intervals (i.e. every 3-4 minutes with a little variation, and then every 2-3 as the cervix opens more than 7 cm). Contractions may come in double peaks, a big one with a lingering second peak, like a hiker pulling a dog on a leash. And sometimes a cluster of big contractions may come and then some not so strong ones follow until the next big trio of waves return. These are contraction variations that tell us the uterus is working to fit the baby through the pelvis. The contractions are pretty steady, but the cervix opens slowly due to a close fit between the mom and baby.

Labor can be long without the cause being the baby’s fit. For instance, did the woman have a pinch of her cervix removed in her past for testing? The scar tissue that resulted from this test could prevent the cervix from opening until the contractions have been super strong for hours. Then suddenly the cervix opens and can actually open from 2 cm to 10 cm in 15 to 60 minutes. That event has nothing to do with fetal position. I mention it to remind us all, it’s not always about fetal position.

Start and stop: Sometimes the uterus gets tired and stalls. The contractions are less painful and the mother can sleep. Sometimes this happens after the uterus has accomplished a goal, such as fetal rotation or engagement. Fetal rotation is labor progress even when the cervix hasn’t changed or hasn’t changed much. After the rest, the contractions will return with strength and the labor is very likely to advance faster and more like a “normal” labor, meaning, as it had been expected before the stall.

Strong and stronger with no descent: Sometimes the uterus is working so hard, really trying to get the baby to rotate and descend. The mother gets no break. We want to see if labor is advancing by bringing the baby lower, even if so gradually that it takes a few vaginal exams to notice, that’s fine as long as mother and baby are fine.

Compare that to the baby that can’t fit at all. The baby will be in the optimal, ideal or perfect position. Your efforts will have brought the baby to LOA and yet the baby remains high, wherever the pelvis was too small to let baby down. Can the pelvis be opened enough to let baby through? If yes, you will have progress.

If no, then, thank God there is the cesarean. It’s telling the true difference that requires experience.

Is the baby known to be posterior? When labor is long due to the baby coming INTO the pelvis in the posterior position, we want to know if the baby will continue to fit in the posterior position or be able to rotate. We don’t usually get to know this, so we can have an educated guess. If labor is moving along readily, we can assume it will continue to do so. If labor is slow, we can hope the baby fits. We can choose to be patient or we can try to rotate the baby.

Spinning Babies is the active side of patience.

Is labor long because baby is too big?

Sometimes the baby gets stuck, actually, on the pelvis and can’t get past. This can be looked at as if the baby can’t fit, perhaps the doctor says the baby is too large. But if the baby is posterior, it isn’t likely that the baby is too large, but rather that the baby’s current head circumference is too large. There is a difference.

Help the baby’s chin tuck to get a smaller head circumference.

Rotate the baby so the head is coming down from a different angle.

Open the pelvis wider with mother’s own positions (these activities and postures are called maternal positioning)

Other reasons for long labor

Laboring woman has a pendulous uterus. Wearing a pregnancy belt, rebozo, or otherwise lifting and supporting the abdomen can bring the baby down with contractions!

Emotional safety needs to be heightened

Privacy needs to be protected, sometimes watchers, and sometimes even helpers, need to back off

Love and laughter

A need for doula CPR — Comfort, Praise, and Reassurance given honestly and appropriately.

Cord wrapping. A cord wrapped around part of the baby may lengthen the labor. In time, the uterus will come down and allow the baby lower. Fetal heart rate decels that are Not the late decel type (the more dangerous type) can be heard or seen, if recording the heart rate on paper, occasionally in labor. Cord wrapping, even around the neck, is not usually life threatening. Your provider will watch carefully to tell if its safe to wait, which it usually is. Meanwhile, have patience and let your uterus do the pushing during 2nd stage. The baby may stay high for a long time and then suddenly descend through the pelvis quickly in a few contractions at the end of second stage. Trust that your baby knows what to do here. Most of the time wrapped cords are not detected until seen.

Did the woman have a pinch of her cervix removed in her past for testing? The scar tissue that resulted from this test could prevent the cervix from opening until the contractions have been super strong for hours. Then suddenly the cervix opens and can actually open from 2 cm to 10 cm in 15 to 60 minutes. That event has nothing to do with fetal position. I mention it to remind us all, its not always about fetal position.

Comparing OA and OP labor patterns

A posterior labor is different than an anterior labor. The position of a “sunny-side up baby,” one facing the front, is called occiput posterior. A posterior baby fits less easily than the anterior baby. A posterior baby’s head seems bigger because of the angle it’s in when in the pelvis.

When a baby starts labor with his or her back on mother’s right, or along the mother’s spine, labor may be longer, and sometimes may even need a doctor’s intervention to finish the birth with Pitocin IV, a vacuum and/or by cesarean.

Other posterior babies come out with little fuss. A few babies don’t even need to rotate to come out. They might even come out in just a few hours of labor. We can’t panic just because the baby is posterior. Most posterior babies turn around, rotate, to the anterior during labor.

There are signals that may help you determine whether a baby is in the occipital posterior position. These signals may also show up in labors where the baby has to get symmetrical for labor to progress, whether or not the long labor is caused by a posterior position. These labor patterns describe labors for women with round or triangular pelvises.

Women with an anthropoid or oblong pelvis is longer front to back than side to side and can have a rather quick and straight forward posterior labor (24-32 hours, no extreme back pain, maybe no back pain, and no start and stop pattern, etc.)

OA vs. OP Labor Patterns

Anterior (ideal)

Posterior (sunny side up)

In latent labor:

Gradual onset

Start & stop pattern common

Short contractions that get longer

Contractions can start very long and get shorter later

Mild contractions get stronger

Can seem like transition in latent labor and get milder later

In early labor:

Manageable if not fearful

Often no back labor yet

Occasionally a 3-4 cm lull

Strong contractions but dilation not more than 3-4 cm.

Time to 4 cm not clinically important – meaning healthy women can eat; labor at home now etc.

Time to 4 cm can be 24 hrs if rotation needed to enter brim

In active labor:

Primip rotation typical at 5 cm

Rotation if roomy midpelvis

5cm is an emotional time

5 cm can be peak of pain if rotation happens then; transition can seem milder

8 cm peak of labor pain

Lull at 6 and lip at 9

Symmetrical contraction pattern

Contractions double peak; cluster

Pushing:

Lull of 5-30 min is common

Lull of one or several hours before urge to push at 10 cm

Lull possible when flexion is slight and molding necessary

Contractions can be spaced far in long labor; mother could rest between

Ok to curl back and tuck chin

Straight or arched back helps baby fit and descend better than a curled back

You can do activities before and during labor that help the baby rotate sooner or more easily. These activities and techniques may even reduce the need for medical interventions. Not all, but most women will find benefits from applying this information. Remember to start with the 3 Principles.

No Spin?

Helping baby into an ideal position in pregnancy isn’t the only goal at Spinning Babies. Easier labor progress is the reward for taking the time to prepare everyday in pregnancy. Here’s what I mean:

I wasn’t able to turn my posterior baby but all the effort using techniques from Spinning Babies helped to keep my labor progressing and I didn’t have back labor at all despite her position. You guys were a life saver!